Duke PA Chronic Kidney Disease
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| progressive and irreversible loss of kidney function | chronic kidney disease
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| two most common causes of chronic kidney disease | diabetes, hypertension
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| in the united states approximately ___ million people have chronic kidney disease | 20
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| the most specific tool to reach a difinitive diagnosis of chronic kidney disease | biopsy
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| interventions that reduce intraglomerular pressure such as ___, help attenuate progression of renal disease | ACEIs, ARBs, protein restriction
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| aggressive management of ___ attenuates the rate of progression of renal failure | hypertension
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| the target BP is <__ in patients with hypertension and diabetes or kidney disease | 130/80
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| meds that block the production or effect of angiotensin II have a ____ | nephroprotective effect
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| recent research has shown that dietary restriction of ___ tends to slow the rate of progression of renal insufficiency | protein
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| the recommended dietary intake for a patient with chronic kidney disease is ___g/kg/day | 0.6
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| ___ should be restricted, especially in patients who are hypertensive and edematous | sodium
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| in hospitalized patients ___ are on of the most common nephrotoxic drugs | aminoglycosides
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| by inhibiting vasodilatory ____ COX-2 inhibitors can decrease GFR, as well as cause acute interstitial nephritis | prostaglandins
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| ___ agents can cause acute or acute-on-chronic renal failure in hospitalization patients | radiocontrast
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| patients at high risk for contrast induced acute renal failure should receive | intravenous fluids with 50mEq bicarbonate 8-10 hours before and after the procedure
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| patients with renal failure usually become symptomatic when the GFR is <__mL/min | 10
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| ___ can cause symptoms of fatigue, N/V, and headaches | urea
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| mortality from cardiovascular disease in patients with renal failure is __ times that of age matched population | 3.5
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| Heart disease accounts for morht than __% of the deaths in patients with uremia | 50
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| ___ contribute to LVH and CHF | anemia and hypertension
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| ___ can occur in patients with uremia | pericarditis
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| patients with renal failure usually describe ___ and loss of appetite | metallic taste
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| lethargy, irritability, frank encephalopathy, asterixis, and seizure are late manifestations of ___ an are usually avoided by early dialysis | uremia
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| peripheral neuropathy manifest in a | glove and stocking distribution
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| peripheral motor impairment can result in | restless legs, foot drop, or wrist drop
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| peripheral neuropathy can result in | decreased distal tendon reflexes and loss of vibratory perception
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| over time adaptive parathyroid hypertrophy becomes maladaptive and leads to | bone disease and tissue calcification
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| ___ becomes progressively deficient as renal function declines | erythropoietin
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| ___ are common causes of anemia in chronic kidney disease patients | erytropoietin and iron deficiency
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| chronic kidney disese patients are generally | immunosuppressed and are susceptible to infection
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| as renal function diminishes, many patients with diabetes will have | decreased insulin requirment, which can lead to hypoglycemic episodes
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| ___ is a common complaint of patients in renal failure | pruritis
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| abnormality present for more than 3 months | chronic
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| abnormal marker of kidney damage (proteinuria), diminished kidney function (GFR <60) | kidney disease
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| CRF, and CRI | outdated terms for Chronic Kidney Disease (CKD)
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| four most common causes of CKD in order of greatest to least | Diabetes, hypertension, glomerulonephritis, cystic kidney disease
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| inability to excrete sodium and water leads to | fluid accumulation, hypertension, edema
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| inability to excrete potassium leads to | cell membrane potential disorders
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| inability to excrete calcium and phosphorus leads to | bone metabolism, cell membrane instability
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| inability to of kidneys to control acid/base leads to | disfunction of cells and enzymes
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| cardiovascular disorders caused by uremia | Arrhythmias, accelerated atherosclerosis, cardiomyopathy
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| gastrointestinal disorders caused by uremia | Nausea, anorexia, dysgusia
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| neurological disorders caused by uremia | insomnia, seizures, coma
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| hematological disorders caused by uremia | bleeding, immune dysfunction
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| dermatological disfunction caused by uremia | pruritis
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| kidney failure leads to decreased vitamin D production which leads to | dysregulation of the body’s calcium homeostasis system, causes more bone to be dissolved to increase body calcium which can lead to weakened bones and fractures
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| stage of CKD: Kidney damage with normal or increased GFR (>=90) | 1
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| stage of CKD: Kidney damage with mild decrease GFR (60-89) | 2
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| major treatment decisions are made after GFR decreases below | 60
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| stage of CKD: moderated decrease in GFR (30-59) | 3
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| stage of CKD: severely decreased GFR (15-29) | 4
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| stage of CKD: kidney failure (GFR<15, or on dialysis) | 5
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| the best single quantitative diagnostic measure of the kidney’s ability to filter blood to remove wastes | GFR
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| estimated by determining creatinine clearance | GFR
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| Normal young adults exhibit glomerular filtration rates >__ mL/min/1.73 m2 | 90
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| ___, not just ESRD, is a major risk for people with CKD | premature cardiovascular death
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| Most patients with CKD will die of events related to ___ before ESRD develops | cardiovascular disease
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| for diabetic kidney disease the CKD risk factors are | diabetes, HBP, family history, ethnic minority
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| glomerular disease risk factors for CKD | autoimmune dz, systemic infections, neoplasia, drug or chemical exposure, family history
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| vascular disease risk factors for CKD | HBP, family history, ethnic minority
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| positive correlation between ___ level and risk of CKD | A1C
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| according to the JNC 7 the BP goal for those with CAD or DM is | <130/80
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| who to screen for chronic kidney disease | Diabetes, Hypertension, Relative with kidney failure, Cardiovascular disease
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| normal GFR __ml/min | 100
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| ___ estimates GFR | creatinine clearance
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| formula used to estimate creatinine clearance | Cockcroft-Gault
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| ___ without GFR decline is the first sign of diabetic nephropathy | albuminuria
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| Once albuminuria develops, CKD follows predictable course with expected loss of __ ml/min GFR per year | 4
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| in individuals with diabetest the ___ is the recommended test for CKD | spot urine albumin to creatinine ratio
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| diabetics should be tested for albuminuria ___ | once per year
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| degree of proteinuria predicts | rate of GFR decline
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| GFR tells you | how far you are from the cliff
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| proteinuria tells you | how fast you are approaching the cliff
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| goal #1 in slowing decline in GFR | get BP <130/80
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| step one in getting BP below 130/80 | use and ACEI or ARB
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| when using and ACEI to reduce BP you need to | monitor serum potassium and serum creatinine
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| normal albumin/creatinine ration <__mg/g | 30
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| inflammation/cytokine release leads to___ leading to anemia in CKD | inhibition of erythropoeitin, and apoptosis of erythroblast
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| anemia in males is defined as <__g/dL | 13.5
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| anemia in females is defined as <__g/dL | 12
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| Hgb target in pateints with CKD __g/dL | 11-12 not to exceed 13
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| with anemic CKD patients sufficient iron should be administered to maintain a TSAT of >=__% and a serum ferritin level of >=__ng/ml | 20, 100
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| if your patient has excess phosphate retention you can give a | phosphate binder
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| vitamin D falls ___ in CKD | early
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| PTH ___ early in CKD | early
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| normal PTH is | 70-110
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